This survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak panel, NORC's probability based panel designed to be representative of the U.S. household population. Panel members were randomly drawn from AmeriSpeak. The final stage completion rate is 33.9%. The overall margin of sampling error is +/-4.28 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups. Once the sample has been selected and fielded, and all the study data have been collected and made final, a post-stratification process is used to adjust for any survey nonresponse as well as any non-coverage or under and oversampling resulting from the study specific sample design. Post-stratification variables included age, gender, census division, race/ethnicity, and education. Weighting variables were obtained from the 2018 Current Population Survey. The weighted data reflects the U.S. population of adults age 70 and over. NOTE: All results show percentages among respondents, unless otherwise labeled.

Background: Electronic health record-based portal tools may help patients engage in advance care planning (ACP). We designed and implemented portal-based ACP tools to enable patients to create a Medical Durable Power of Attorney (MDPOA). Intervention: Stakeholder-informed portal-based ACP tools including an electronic MDPOA form, patient educational webpage, online messaging, and patient access to completed advance directives. Measures: MDPOA documentation and System Usability Scale. Outcomes: 2814 patients used the tools over 15 months. Patients were mean age 45 years (17 to 98 years) and 69% were women. 89% completed an MDPOA form, 2% called or sent online messages, and 8% viewed the MDPOA form but did not complete it. The tools were rated highly usable. Conclusions: Patients demonstrated willingness to use the portal to complete an MDPOA and rated the new ACP tools as highly usable. Future work will optimize population-based outreach strategies to engage patients in ACP through the portal.

Purpose The purpose of this study was to understand barriers and facilitators to engagement in a diabetes prevention program for young women at an urban safety-net health care system. Methods Individual semistructured interviews (N = 29) explored motivations, challenges, and successes regarding participation and suggestions for improvement among women aged 18 to 39 years who enrolled in the National Diabetes Prevention Program in the past 2 years. Participants were classified as nonattendees (n = 10), early-withdrawers (n = 9), or completers (n = 10). Interview transcriptions were analyzed using a grounded hermeneutic editing approach. Results Qualitative analysis revealed 4 main themes (enrollment, attendance, experience, and suggestions) with multiple subthemes. Most women were motivated to enroll for health and family concerns. Early-withdrawers and nonattendees reported confusion about the program’s aim and relevancy, logistical barriers, and lack of connection with fellow participants/coaches. Highly engaged women noted persistent motivation, perceived weight loss, and supportive program relationships. Conclusions Multiple barriers/facilitators for young women appear addressable in future adaptations. Additional research is needed to confirm these findings in other settings and explore implementation and effectiveness of adaptations, with a goal of reducing risks prior to conception.

Background: Patient portals can offer patients an opportunity to engage in the advance care planning (ACP) process outside of clinical visits. Objective: To describe patient perspectives on use of patient portal-based ACP tools. Design: Interviews with patients who used portal-based ACP tools. The tools included an electronic Medical Durable Power of Attorney (MDPOA) form to designate a medical decision maker, a patient-centered educational web page, online messaging, and patient access to completed advance directives stored in the electronic health record (EHR). Setting: Regional health-care system with a common EHR. Measurements: Semistructured interviews with purposefully sampled patients who used the ACP tools. Questions explored motivations for using the tools and perceptions about how the tools fit into ACP. Analysis followed a grounded hermeneutic editing approach. Results: From 46 patients (mean age: 49, 63% female), 4 key themes emerged: (1) individualized explorations of the ACP tools, (2) personal initiation and engagement with ACP tools through the portal, (3) value of connecting ACP portal tools to clinical care, and (4) practicality of the ACP tools. Patients described benefits of communicating with health-care team members who referred them to online ACP tools, as well as having the electronic MDPOA form connected to clinical care. Conclusions: Patients considered the portal-based ACP tools to be practical and feasible to use within the scope of their own ACP experiences. Further study is needed to understand whether portal-based ACP tools increase the quality and quantity of ACP conversations and documentation that is available to inform medical decision-making.

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